The analyses of data from the American Migraine Prevalence and Prevention Study presented by Drs. Lipton and Buse and colleagues provide new insights into the treatment and care of patients with migraine headaches. Some of the researchers’ conclusions support prior observations about medications, such as the somewhat complex role NSAIDs play in migraine therapy—particularly for high-frequency migraine. Other results clearly show that changing triptans or other acute agents may not help migraine patients, but lead to more disability. Group data conceivably could mask benefits in subpopulations or individuals, however. Whether the investigators’ findings should affect the practice of treating and managing individual headache patients in general will require more observation and study, as Dr. Lipton implied.
Nevertheless, these high-quality epidemiologic data should prompt reflection among clinicians who manage patients with migraine. What is important here is that the authors not only present their data, but relate them to disability based on a validated tool: the MIDAS score. The bottom line is that the management of migraine outside the occasional attack can be difficult and requires great skill and subtlety. Migraine, as a neurobiologic disorder, is a moving target, so to speak. As it matures, migraine can become more complex through chronification, which can pose major problems for care and long-term management—an area that Dr. Lipton and his colleagues have explored in detail in other studies. Headache specialists will welcome these new insights.
—R. Allan Purdy, MD, FRCPC, FACP, FAHS
Professor of Neurology